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Summary
Dengue virus (DENV) is a member of the viral genus Flavivirus, which also includes yellow fever virus (YFV) and Zika virus (ZIKV). DENV infection is a major and growing global health threat: There are ∼400 million cases of infection, ∼500,000 hospitalizations, and ∼12,500 deaths now estimated to occur each year (1). Dengue represents the most common mosquito-borne disease in humans (1). A remarkable 50% of the world's population now lives in regions where DENV transmission is manifest. Dengue is associated with a wide spectrum of clinical outcomes, ranging from mild febrile illnesses to dengue hemorrhagic fever to the most severe clinical presentation of dengue shock syndrome, which is characterized by profound systemic cytokine activation, vascular leakage, and shock—this carries a high risk of death. On page 929 of this issue, Katzelnick et al. (2) analyzed DENV infection outcome data gleaned from the long-term followup of a cohort of Nicaraguan children (2). They found that the risk of severe dengue disease upon subsequent DENV infection correlated with baseline DENV antibody concentrations (titers), which has implications for DENV vaccination approaches.
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